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Organization
PONTE VEDRA PHYSICAL THERAPY, INC.
Active
Organization
PONTE VEDRA PHYSICAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY C PARKS (PRESIDENT)
(904) 285-2910
Entity
Organization
Contact information
Practice address
880 A1A N, SUITE 18A, PONTE VEDRA BEACH, FL 32082-3221
(904) 285-2910
(904) 285-4663
Mailing address
PO BOX 48116, JACKSONVILLE, FL 32247-8116
(904) 725-1657
(904) 725-7247
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R9F
BCBS
FL
Enumeration date
06/25/2006
Last updated
12/07/2007
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